What Is An Anovulatory Cycle, What Causes It And How To Prevent It?
By definition, an anovulatory cycle is a menstrual cycle in which ovulation fails to occur. This means that you do bleed but do not release an egg or ovulate. Hence the term anovulation. This is normally supposed to happen during menopause. If it does happen before then anovulation translates into difficulty in conception or infertility. Anovulatory cycles tend to occur occasionally throughout the childbearing years, but are most common during adolescence and in the years before menopause (“perimenopause”).
Causes and Prevention of Anovulatory Cycles
Anovulation can arise from a number of causes, ranging from diet and exercise to complex disruptions in the relationships between tiny glands in the brain that control our most basic functions. Some causes are relatively easy to identify, whereas others are much more difficult.
Hormonal imbalances are the most probable cause of anovulatory cycle. A prolonged, strenuous program of exercise, such as running, can interfere with the ovulatory cycle by suppressing the output of hormones called gonadotropins from the hypothalamus in the brain. Anxiety and other forms of emotional stress can also take their toll on normal ovulation.
The disorder may also result from eating disorders, hypothalamic dysfunction, hyperprolactinemia, polycystic ovary syndrome, luteal phase defects, or tumors of the pituitary gland adrenal gland or ovaries. Other causes of anovulatory cycles are primary ovarian failure, resistant ovary syndrome and autoimmune oophoritis.
Another possible contributor to anovulation is the long-term use of certain medications. Steroidal oral contraceptives (the Pill) are sometimes responsible. These drugs work by intentionally disrupting the hypothalamic-pituitary-ovarian axis, suppressing ovulation and thereby preventing pregnancy. For women using long-acting injectable steroid contraceptives (Depo-Provera), it appears likely that the longer the contraceptive is continued the more likely it is that amenorrhea will result.
Once you know the probable causes of anovulation, you must take care to avoid any of these, especially if you have a history of fertility problems. Avoid any strenuous exercise without consultation and do not attempt to try out fad diests as these may lead to anovulatory cycles. Learn to manage stress and develop a healthy lifestyle to keep this disorder at bay.
Diagnostic Tests for Anovulatory Cycles
Anovulation can be difficult to detect. Some women have seemingly normal menstrual periods even though they are not ovulating. Most often, women who do not ovulate also do not menstruate, a disorder known as amenorrhea, or do not menstruate regularly, a condition called oligomenorrhea. Because of this, scant, erratic, short and/or painless menstrual cycles can sometimes alert a woman or her doctor about an anovulation problem.
If you experience bleeding between periods for more than 2-3 cycles, you should notify your doctor immediately. Too many of these anovulatory cycles can contribute to irregular bleeding, or endometrial hyperplasia. A diagnostic test for anovulatory cycles may include the following depending on other factors like your age and medical history.
- Serum assays
- LH (on days 13 and 15 of menstrual cycle, to detect midcycle peak)
- Testosterone and SHBG (for obtaining Free Androgen Index [FAI] or calculated free testosterone levels)
- CT scan or MRI scan of pituitary and hypothalamus
- Endometrial biopsy
- Ovarian biopsy
- Specific antibody tests
Treatment for Anovulatory Cycles
Treatments for anovulatory cycles vary based on the underlying cause of the condition and other factors like age and medical history. For many infertile women with anovulation, treatment with one or another of fertility drugs can be remarkably successful. Clomiphene citrate (Clomid) is often a good first choice for an anovulatory woman who is producing estrogen.
If clomiphene alone is unsuccessful, Pergonal is added to bolster the attempts to ripen a follicle. Pergonal bypasses the natural hormone stimulation of the pituitary on the ovary. It applies stimulation directly to the ovary, and then, once a follicle grows to sufficient size, HCG is used as the final step to release the egg.
Some other treatments that can used in tandem with medication are :
- Medications for specific underlying conditions
- Nutritional modifications
- Stress reduction
- Surgery (in the case of tumors)